经尿道前列腺等离子电切术后出血病人的观察与防治对策

发布时间：2018-02-26 19:45

  本文关键词： 前列腺增生 等离子电切术 术后出血 出血原因 预防 治疗　出处：《泰山医学院》2014年硕士论文　论文类型：学位论文

【摘要】：目的:良性前列腺增生(BPH)为最常见的老年男性疾病,分析与总结经尿道等离子双极电切术(TUPKP)治疗良性前列腺增生术后出血原因及防治方法,评价经尿道等离子电切术治疗前列腺增生症患者的疗效及手术安全性,为泌尿外科微创技术治疗前列腺增生症患者选择最佳的手术方式及治疗方案。方法:回顾性分析了自2006年6月至2013年11月间经尿道前列腺等离子电切术治疗前列腺增生手术850例,所有患者术前均有典型前列腺增生相关症状,其症状与前列腺增生后体积不成正比,辅助检查如彩超、尿流动力学及肛门指诊等,术后所有组织病理学检查证实均为前列腺增生。术后出血的前列腺增生患者30例,年龄55-78岁,平均年龄65.8岁,病程1-5年,平均2.6年。经尿道前列腺等离子电切术后出血患者的临床资料,分析总结患者出血原因、治疗及预防方法。根据出血量多少情况进行分组,出血测定应用MACRO精子计数器观测,导出公式为:含血量(ml)=液体量(ml)×平均每小格红细胞数×107每毫升血中红细胞数)分成两组,以冲洗液中30ml/h含血量为标准,其中对照组出血量小于标准量采用保守治疗,观察组出血量大于标准量采用返回手术室进行治疗,观察两组的治疗效果和止血情况。结果:30例患者术后出血均止血成功。术后给予相同膀胱冲洗速度,冲洗速度为6000ml/6h,并且化验尿常规及血常规,血常规均在正常范围。按照术后出血量计算结果情况进行分组,其中对照组出血量小,为冲洗液呈淡红色者20例,应用MACRO方法计算失血量均30ml/h,年龄46-57岁,平均年龄为(56.5±8.3)岁;体重48-65kg,平均体重(53.57±6.43)kg,病程1-4年,平均病程(1.56±1.03)年,出血时间术后2-4h内10例,术后7d内6例,术后3个月内4例。观察组出血量大,冲洗液呈鲜红色者10例,应用MACRO方法计算失血量均30ml/h,年龄55-78岁,平均年龄为(67.6±8.4)岁;体重57-76kg,平均体重(64.36±6.59)kg,病程1-5年,平均病程(2.62±1.06)年,出血时间术后2-4h内7例,术后7d内2例,术后3个月内1例。治疗原则同一般性血尿,必要给予如手术室行膀胱镜检查或电凝止血,重点为治疗诱发前列腺电切术后出血的原发病及出血原因的预防及治疗。经过综合分析术后出血原因为:(1)术前有基础疾病(如冠心病10例次、糖尿病9例次、泌尿系感染10例次、高血压13例次、慢性支气管炎及肺气肿5例次及各种原因导致的凝血酶原延长及出血倾向)。(2)术中前列腺切除不彻底,残留前列腺组织过多,术后前列腺窝发生感染,术中损伤前列腺包膜、止血不彻底等。(3)术后过度活动、疼痛及腹压增加、用力不当、便秘等因素有关,术后应激反应等造成凝血功能下降。结论:经尿道前列腺等离子电切术后出血原因及止血效果比较和评价,术前、术中、术后及时准确处理是减少术后出血的非常关键因素,基本表现为三类:(1)、术前准备匆忙不充分,(2)、术中操作欠规范或手术者掌握手术程度不熟练,(3)、术后观察处理不及时。术前完善各项必要检查,手术适应症必须严格把关;术中规范操作,手术者必须能够熟练掌握手术操作,以精阜为标志,切除前列腺到外包膜,切除创面平整,止血彻底;术后及时观察对症处理,抗生素应用预防感染,做好病人的指导工作。轻度出血可采用保守治疗,给予加大膀胱冲洗速度,保持各引流管通畅,口服止血药物如云南白药胶囊等,治疗基础病或原发病;重度出血可以给予应用静脉止血药物如血凝酶等、补足血容量及快速膀胱冲洗等,如血凝块发生膀胱填塞时应及时清除血凝块,有明显出血者给予手术电灼止血,当病人无明显出血后重新放置导尿管,保持膀胱冲洗和引流通畅。
[Abstract]:Objective: benign prostatic hyperplasia (BPH) is the most common disease of older men, the analysis and summary of transurethral plasmakinetic resection (TUPKP) causes and methods of prevention and treatment of bleeding after transurethral prostatectomy, evaluate the efficacy and safety of surgical resection for the treatment of benign prostatic hyperplasia with transurethral plasmakinetic, minimally invasive technique for Department of Urology the treatment of benign prostatic hyperplasia patients choose the best surgical approach and treatment. Methods: a retrospective analysis from June 2006 to November 2013 between transurethral plasmakinetic resection of prostate for treatment of benign prostatic hyperplasia surgery in 850 cases, all patients had typical hyperplasia of prostate related symptoms, the symptoms and hyperplasia of prostate gland is not proportional to the auxiliary examination such as ultrasound, urodynamics and DRE, postoperative histopathological examination confirmed prostatic hyperplasia after blood prostate. 30 cases of patients with hyperplasia, 55-78 years of age, the average age of 65.8 years, the duration of 1-5 years, an average of 2.6 years. The clinical data of patients with hemorrhage after transurethral resection of prostate, analysis the reasons of hemorrhage, prevention and treatment methods. Group according to how much the amount of bleeding, bleeding by MACRO sperm counter observation, export formula: blood containing liquid volume (ML) = (ML) * the average number of red blood cells * 107 cells per milliliter of blood red blood cells) were divided into two groups, with washing liquid blood containing 30ml/h as the standard, the control group was less than the standard amount of bleeding with the conservative treatment, observation group on bleeding volume the amount of the standard return operation room for treatment, observe the curative effect and hemostasis in two groups. Results: 30 cases of patients with postoperative bleeding was successful. After given the same bladder washing speed, flushing rate is 6000ml/6h, and testing urine and blood often 瑙，

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